Provider Demographics
NPI:1609077676
Name:FINE LINES COSMETIC LASER CNT
Entity Type:Organization
Organization Name:FINE LINES COSMETIC LASER CNT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRONWEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:DARBONNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-783-2426
Mailing Address - Street 1:717 N EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-3856
Mailing Address - Country:US
Mailing Address - Phone:337-783-2426
Mailing Address - Fax:337-783-2483
Practice Address - Street 1:717 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-3856
Practice Address - Country:US
Practice Address - Phone:337-783-2426
Practice Address - Fax:337-783-2483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center